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With healthcare spending consuming 17.2% of GDP and showing no signs of slowing, Dr. Tony Zitek, Chief Resident of Emergency Medicine at the University of Nevada School of Medicine at Las Vegas has a simple idea to reduce healthcare costs from the “bottom up.”“We tell doctors how much the tests they are ordering cost and see what happens,” proposes Dr. Zitek.And so he did. Dr. Zitek, along with Dr. Ross Berkeley, University Medical Center (UMC) Department of Emergency Medicine Vice-Chair for Quality and Education, prepared a brief powerpoint presentation for UMC health care providers detailing the costs of 34 commonly ordered laboratory tests, highlighting especially costly lab choices.“A CMP costs only $1 more than a BMP at our institution,” explained Dr. Zitek. “It never makes sense to order a BMP and LFTs – just get the CMP, which contains essentially the same information at a far lower cost.”Dr. Zitek’s presentation also pointed out that the GC/Chlamydia swab is in fact the most expensive commonly ordered lab test at UMC. Many providers were unaware that this routinely requisitioned test was so costly, totaling several hundred dollars. “Often empiric treatment is more cost-effective than further testing with this presentation.”

The results of Dr. Zitek’s educational intervention surprised even him. Overall lab utilization rate fell by 4.3% over the next three months. Substitution of the CMP test for BMP/LFT testing caused savings of a staggering $723,553. GC/Chlamydia testing fell by 57.2%, yielding $125,985 in hospital cost reduction. In sum, over a three month period, the hospital saved nearly $1 million. And while Dr. Zitek pooh-poohs his efforts as too “easy” to merit much fanfare, the simplicity of his intervention – combined with the formidable cost savings that resulted – is likely to earn the attention of those looking at ways to make health care more efficient and cost-effective going forward.Further investigation involving multiple medical centers certainly seems warranted.Dr. Zitek presented his results at the 2015 Annual Meeting of the Society for Academic Emergency Medicine (SAEM 2015) held in San Diego May 13, 2015.“Patients Don’t Want the ‘Whole Nine Yards’”Also presenting before SAEM physicians and onlookers was Vegas Emergency Medicine Residency newcomer Clayton Wu, who will be joining the incoming intern class in the Fall but decided to get a head start on the research front.

Also presenting before SAEM 2015 physicians and onlookers was Vegas Emergency Medicine Residency newcomer Clayton Wu, who will be joining the incoming intern class in the fall but decided to get a head start on the research front.“If you fall and hit your head and imaging shows you have a small bleed in your brain, standard of care is that you are observed in the hospital – and typically the ICU – for 48 hours,” explains Clayton. But recent studies have suggested that for many of these patients, observation on the floor results in equivalent clinical outcomes, not to mention cost savings to the patient. One concern limiting widespread adoption has been "the thought that patients prefer ICU admission due to perceptions of higher quality care" there. Clayton designed a questionnaire assessing this issue and posed it to waiting room patients at the UC Davis Medical Center. His survey results confirmed that patients felt they would get better care in the ICU but, counterintuitively, found they preferred to be placed on the floor regardless. Clayton speculates that this unusual finding might be due to previous experience with being in the ICU – or with loved ones in the ICU – and associating the space with negative health outcomes. Whatever the case, Clayton’s results show that patient preference may in fact be in line with evidence-based admissions in low-risk traumatic intracranial hemorrhage patients.Rounding Out the ListDr. Walt Grenell’s poster “No Survival Benefit from Prehospital Induced Therapeutic Hypothermia in Out-of-Hospital Cardiac Arrest” was also featured among the e-poster presentations at SAEM 2015. Dr. Grenell regrets that he could not make the event this year. Other Las Vegas Emergency Medicine Residents appearing at SAEM 2015 were Dr. Meaghan Mercer, who also serves as President of the American Academy of Emergency Medicine Resident and Student Association (AEEM/RSA), incoming Vegas EMR Chief Residents Drs. Carrie Cook and Sean Weaver, and incoming Vegas EMR FOAM Associate Editor Zachary Skaggs

Key opinion leaders playing major role in healthcare industries. If you want ideas and suggestions to make your clinical business more profit just get the help from them.

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